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1.
JCO Glob Oncol ; 8: e2100371, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-2196622

ABSTRACT

PURPOSE: COVID-19 caused a disruption in cancer management around the world, resulting in an estimated excess burden secondary to screening disruption and excess lag time for treatment initiation. METHODS: We gathered information from primary reimbursement data sets of the public health system of São Paulo, Brazil, from April 2020 to November 2021, and compared these data with those of the pre-COVID-19 period. We used an interrupted time series model to estimate the effect of the COVID-19 pandemic on the rate of key procedures of breast and cervical cancer health care chain. RESULTS: We estimated that 1,149,727, 2,693, and 713,616 pap smears, conizations, and mammograms, respectively, were missed or delayed during the COVID-19 pandemic, compared with those in the years immediately before the COVID-19 stay-at-home restrictions. Specifically, we observed an acute decrease of procedures after the COVID-19 stay-at-home restrictions, with a trend to recovery in the long term. Regarding the systemic treatment analysis, we observed a 25% reduction in the rate of initiation of adjuvant systemic treatment for early breast cancer (stage I/II). However, we did not find a clear effect on the other settings of systemic treatment for breast cancer. We estimated an excess of 156 patients starting palliative care for cervical cancer after the COVID-19 stay-at-home restrictions. CONCLUSION: The COVID-19 pandemic significantly reduced the performance rate of pap smears, conizations, and mammograms. The initiation of adjuvant treatment for early-stage breast cancer was most susceptible to COVID-19's health system disruption. Furthermore, the downward trend of treatment of advanced cervical cancer was interrupted. Therefore, public health policies are urgently needed to decrease the incidence of advanced cervical and breast cancers caused by delayed diagnosis and treatment initiation.The COVID-19 control policies resulted in reduction of cancer patients' delivery of care. This study evaluated the pandemic's influence in key procedures of breast and cervical cancer chain of care in São Paulo, Brazil. We observed a substantial reduction in the number of mammograms, pap smears, and conizations performed since the onset of the COVID-19 pandemic. In addition, stage I and II breast cancer adjuvant treatment presented a reduced realization rate, whereas palliative treatment delivered for advanced cervical cancer increased. Our results support the need for public health policies focused on mitigating the long-term effects of COVID-19 in cancer-related mortality.


Subject(s)
Breast Neoplasms , COVID-19 , Early Detection of Cancer , Uterine Cervical Neoplasms , Brazil/epidemiology , Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , COVID-19/epidemiology , Early Detection of Cancer/statistics & numerical data , Female , Humans , Interrupted Time Series Analysis , Pandemics , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/therapy
2.
Surg Innov ; 29(6): 814-816, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2195311

ABSTRACT

BACKGROUND: The current simulators for teaching oncoplastic surgery marking are available in a fixed size for each model. This is not an accurate reflection of the variety of patient's breast volumes in reality and may limit the teaching to certain techniques associated with the particular breast ptosis/size. DEVICE DESCRIPTION: This is the first reported simulator with varying breast volumes/ptosis in a single model for teaching oncoplastic surgery marking, known as Adjustable Breast Oncoplastic Surgery Simulator (ABOSS). Adjustable Breast Oncoplastic Surgery Simulator was created using 3D printing. PRELIMINARY RESULTS: Adjustable Breast Oncoplastic Surgery Simulator could simulate the breast in appearance and texture. It is inexpensive and allows the practice of various markings based on the different breast volumes/ptosis in a single model. It also allows for the practice of the marking needed in asymmetric breasts to correct the asymmetry. CURRENT STATUS: Plans for commercialisation were made.


Subject(s)
Breast Neoplasms , Mammaplasty , Humans , Female , Mammaplasty/methods , Mastectomy, Segmental/methods , Mastectomy/methods , Breast/surgery , Printing, Three-Dimensional , Breast Neoplasms/surgery
3.
J Med Genet ; 59(12): 1179-1188, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2193899

ABSTRACT

BACKGROUND: Germline genetic testing affords multiple opportunities for women with breast cancer, however, current UK NHS models for delivery of germline genetic testing are clinician-intensive and only a minority of breast cancer cases access testing. METHODS: We designed a rapid, digital pathway, supported by a genetics specialist hotline, for delivery of germline testing of BRCA1/BRCA2/PALB2 (BRCA-testing), integrated into routine UK NHS breast cancer care. We piloted the pathway, as part of the larger BRCA-DIRECT study, in 130 unselected patients with breast cancer and gathered preliminary data from a randomised comparison of delivery of pretest information digitally (fully digital pathway) or via telephone consultation with a genetics professional (partially digital pathway). RESULTS: Uptake of genetic testing was 98.4%, with good satisfaction reported for both the fully and partially digital pathways. Similar outcomes were observed in both arms regarding patient knowledge score and anxiety, with <5% of patients contacting the genetics specialist hotline. All progression criteria established for continuation of the study were met. CONCLUSION: Pilot data indicate preliminary demonstration of feasibility and acceptability of a fully digital pathway for BRCA-testing and support proceeding to a full powered study for evaluation of non-inferiority of the fully digital pathway, detailed quantitative assessment of outcomes and operational economic analyses. TRIAL REGISTRATION NUMBER: ISRCTN87845055.


Subject(s)
Breast Neoplasms , Referral and Consultation , Humans , Female , State Medicine , Telephone , Genetic Testing , Breast Neoplasms/diagnosis , Breast Neoplasms/genetics , United Kingdom
5.
preprints.org; 2023.
Preprint in English | PREPRINT-PREPRINTS.ORG | ID: ppzbmed-10.20944.preprints202301.0413.v1

ABSTRACT

Abstract. Marek's disease virus is an oncogenic avian herpesvirus and the problem of oncogenicity of this virus for humans remains unexplored. This pathology appeared in broiler chickens of 30 days and older, that is from now on the contact with poultry meat carries the risk of infecting people. This article analyzes the risks of the emergence of the epidemic potential of the Marek's disease virus in the Russian Federation taking into account the characteristics of modern pig and poultry farming. It was found that COVID 19 can serve as an additional factor in reducing the resistance of the population to herpesvirus infections. The COVID 19 epidemic is accompanied by folic acid deficiency which also increases the risk of contamination of diseases associated with DNA viruses, including an extended risk of animal viruse infection. Since, according to our estimates, Marek's disease occurred in at least 25% of broiler poultry farms in the Russian Federation, a possible expand in mortality from neoplasms of the reproductive system for the Russian Federation as a whole can contribute to the dynamics of oncological diseases of reproductive organs and breast cancer. Since 2011 a contagious form of intestinal pathology, vesicular enteritis, has widely spread at poultry farms in the Russian Federation. During periods of extending incidence of vesicular enteritis, we recorded cases of inflammation of the facial nerves and subfebrile temperature in contact persons, bursts of oncological diseases in veterinary personnel (ovarian cancer, breast cancer), abnormal and synchronous increases in the incidence of infectious larengotracheitis and Marek's disease in chickens under the age of 40 days which requires additional monitoring studies.


Subject(s)
Communicable Diseases , Marek Disease , Enteritis , Herpesviridae Infections , Ovarian Neoplasms , Neoplasms , Breast Neoplasms , Inflammation
6.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2508078.v1

ABSTRACT

Purpose This study aimed to determine the cancer screening behaviors of women over 30 and the factors affecting them during the Covid-19 pandemic.Methods This cross-sectional study was conducted with 301 women aged 30 and over in Edirne, the border province in northwest Turkey. Study data were collected with the Personal Information Form and Turkiye Health Literacy Scale-32 (THL-32).Results The mean age of the participants was 43.66 ± 9.02; 65.1% were between the ages of 30–49, and 85% were married. 74.8% of the participants did not have a screening test during the pandemic. Women underwent breast examination (32.2%), pap smear test (21.9%), and fecal occult blood test (19.9%), respectively, with an attending physician. The mean health literacy score of the participants was 28.18 ± 7.55, and the majority (80.7%) were in the category of inadequate-limited health literacy. The mean health literacy score and breast cancer screening were statistically significant (p < 0.05).Conclusion The study group's participation status and health literacy levels in cancer screening tests were low. The COVID-19 pandemic period negatively affected the individuals' participation in screening tests.


Subject(s)
COVID-19 , Neoplasms , Breast Neoplasms
7.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2488233.v1

ABSTRACT

Cognizance of the implication of Covid-19 pandemic on health and well-being resulted in an upsurge is use of several dietary and herbal supplements (DHS) for the prevention and/or prophylaxis against the new disease.  Objectives: To evaluate the pattern of DHS consumption among Nigerians with Non-communicable Diseases (NCD) for the prevention and treatment of COVID-19.  Design: Cross-sectional questionnaire survey. Setting: Adolescents, and adults residing in Nigeria.  Participants:Participants with NCD (n = 165) from a larger study (n=645) were recruited from different geo-political zones and various ethnic groups.  Primary and Secondary Outcomes: Prevalence and determinants for the use of different DHS for the prevention and treatment of COVID-19 in Nigeria, and sources of information for DHS use.  Results: Hypertension was the most prevalent NCD (63.6%) in the study and both breast cancer and anxiety disorder were the least (0.6%). A minimum (75.2%) of the respondents had less than 8 hours of sleep daily and almost all did not smoke cigarette at all. The proportion of male and female hypertensives who believed that dietary supplements are necessary during infectious disease outbreak such as Covid-19 was moderately high (55.2%), higher among asthmatics (65.0%), diabetes (58/105, 68.4%), those with kidney disease (100.0%), ulcer (83.3%) and liver disease. Almost all the respondents with hypertension (101/105, 96.2%), asthma (19/20, 95.0%), diabetes (19/19, 100.0%) and kidney disease (6/6, 100.0%), consumed supplements more during Covid-19 pandemic in Nigeria. The proportion of those who consumed supplements more during the pandemic in Nigeria was higher among male hypertensives (57/101, 56.4%) than among the female (44/101, 43.6%), though the difference was not significant (χ²=2.93, P-value=0.09). Vitamin C was the commonest vitamin taken by respondents with ulcer (83.3%), kidney disease (83.3%), diabetes (57.9%), asthma (50.0%), hypertension (48.6%) and the two respondents with breast cancer (1, 100.0%) and anxiety disorder (1, 100.0%) respectively. Calcium and zinc were the commonest minerals taken by respondents with ulcer (50.0%, 16.7%), diabetes (10.5%, 5.3%), asthma (30.0%, 10.0%) and hypertension (13.3%, 11.4%) respectively. High proportions (83.3%, 80.0%) of those with kidney disease and with asthma consumed DHS to maintain good health. Health workers were the dominant source of information for most on the use of supplements during Covid-19 pandemic in Nigeria.  Conclusions: The findings showed widespread use of DHS for the prevention and treatment of COVID-19 among persons with NCD. The use of DHS in this study was mainly guided by health workers with a marginal role of social media and Mass media. These findings call for a more robust consolidative tactic towards DHS to ensure its proper and safe use.


Subject(s)
Liver Diseases , Ulcer , Communicable Diseases , COVID-19 , Hypertension , Asthma , Kidney Diseases , Anxiety Disorders , Breast Neoplasms , Diabetes Mellitus
8.
BMC Cancer ; 22(1): 141, 2022 Feb 04.
Article in English | MEDLINE | ID: covidwho-2162322

ABSTRACT

BACKGROUND: As the combination of systemic and targeted chemotherapies is associated with severe adverse side effects and long-term health complications, there is interest in reducing treatment intensity for patients with early-stage breast cancer (EBC). Clinical trials are needed to determine the feasibility of reducing treatment intensity while maintaining 3-year recurrence-free survival of greater than 92%. To recruit participants for these trials, it is important to understand patient perspectives on reducing chemotherapy. METHODS: We collected qualitative interview data from twenty-four patients with Stage II-III breast cancer and sixteen patient advocates. Interviews explored potential barriers and facilitators to participation in trials testing reduced amounts of chemotherapy. As the COVID-19 pandemic struck during data collection, seventeen participants were asked about the potential impact of COVID-19 on their interest in these trials. Interviews were audio-recorded and transcribed, and researchers used qualitative content analysis to code for dominant themes. RESULTS: Seventeen participants (42.5%) expressed interest in participating in a trial of reduced chemotherapy. Barriers to reducing chemotherapy included (1) fear of recurrence and inefficacy, (2) preference for aggressive treatment, (3) disinterest in clinical trials, (4) lack of information about expected outcomes, (5) fear of regret, and (6) having young children. Facilitators included (1) avoiding physical toxicity, (2) understanding the scientific rationale of reducing chemotherapy, (3) confidence in providers, (4) consistent monitoring and the option to increase dosage, (5) fewer financial and logistical challenges, and (6) contributing to scientific knowledge. Of those asked, nearly all participants said they would be more motivated to reduce treatment intensity in the context of COVID-19, primarily to avoid exposure to the virus while receiving treatment. CONCLUSIONS: Among individuals with EBC, there is significant interest in alleviating treatment-related toxicity by reducing chemotherapeutic intensity. Patients will be more apt to participate in trials testing reduced amounts of chemotherapy if these are framed in terms of customizing treatment to the individual patient and added benefit-reduced toxicities, higher quality of life during treatment and lower risk of long-term complications-rather than in terms of taking treatments away or doing less than the standard of care. Doctor-patient rapport and provider support will be crucial in this process.


Subject(s)
Breast Neoplasms/drug therapy , Breast Neoplasms/psychology , Patient Advocacy/psychology , Adult , Aged , Breast Neoplasms/pathology , COVID-19/epidemiology , Decision Making , Fear/psychology , Female , Humans , Interviews as Topic , Middle Aged , Motivation , Qualitative Research , Quality of Life
9.
Oncol Res Treat ; 45(11): 681-692, 2022.
Article in English | MEDLINE | ID: covidwho-2162084

ABSTRACT

BACKGROUND: Metronomic chemotherapy (MCT), termed sustained low-dose administration with minimal toxicity, is a new modality of conventional chemotherapy, a verified therapy alternative, and has acquired significant recognition and interest in oncology. Numerous clinical trials of MCT in combination with other treatments, including targeted therapies, biologics, and endocrine therapy, are in progress to obtain better results. SUMMARY: We comprehensively described the clinical benefits of MCT in combination with other treatments in different molecular subtypes of breast cancer and assessed the feasibility of its adoption in varying phases of treatment. Due to the promising preclinical and clinical investigations, it is expected that MCT in combination with other treatments will enhance the advantages of this strategy and apply it to clinical practice. KEY MESSAGE: MCT, in combination with other therapeutic interventions, will fully exploit the benefits of this strategy, ushering in a new paradigm in oncology treatment and driving the transformation of cancer into a more manageable chronic disease using newly developed treatment approaches.


Subject(s)
Breast Neoplasms , Humans , Female , Breast Neoplasms/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use
10.
Rev Saude Publica ; 56: 88, 2022.
Article in English | MEDLINE | ID: covidwho-2155809

ABSTRACT

We have previously reported the impact of covid-19 pandemic on breast cancer screening, in Brazil: among women aged 50-69 years, mammography attendance decreased by 42% in public healthcare (SUS), comparing 2019 and 2020. In this short communication, we wish to present: a) an update of the number of mammograms performed, in 2021; b) an exploratory analysis of the characteristics of the screened population between 2019 and 2021. A total of 1.675.307 mammograms were performed in 2021, nearly 15% lower than pre-pandemic levels. Almost a third, 29.5% of them, had intervals greater than three years. In accordance with our previous study, the number of patients with palpable lumps on physical exam increased. The consequences of postponing breast cancer screening during the pandemic are still uncertain. Unfortunately, as of December 2021, screening attendance has not resumed. On the contrary, our results show an increase in the fraction of women with mammography delayed beyond three years.


Subject(s)
Breast Neoplasms , COVID-19 , Humans , Female , Early Detection of Cancer , Breast Neoplasms/diagnostic imaging , Pandemics/prevention & control , Brazil/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology
11.
BMJ Open ; 12(11): e063895, 2022 11 17.
Article in English | MEDLINE | ID: covidwho-2152994

ABSTRACT

INTRODUCTION: Socioeconomic disparities for breast cancer surgical care exist. Although the aetiology of the observed socioeconomic disparities is likely multifactorial, patient engagement during the surgical consult is critical. Shared decision-making may reduce health disparities by addressing barriers to patient engagement in decision-making that disproportionately impact socioeconomically disadvantaged patients. In this trial, we test the impact of a decision aid on increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making. METHODS AND ANALYSIS: This multisite randomised trial is conducted through 10 surgical clinics within the National Cancer Institute Community Oncology Research Program (NCORP). We plan a stepped-wedge design with clinics randomised to the time of transition from usual care to the decision aid arm. Study participants are female patients, aged ≥18 years, with newly diagnosed stage 0-III breast cancer who are planning breast surgery. Data collection includes a baseline surgeon survey, baseline patient survey, audio-recording of the surgeon-patient consultation, a follow-up patient survey and medical record data review. Interviews and focus groups are conducted with a subset of patients, surgeons and clinic stakeholders. The effectiveness of the decision aid at increasing patient engagement (primary outcome) is evaluated using generalised linear mixed-effects models. The extent to which the effect of the decision aid intervention on patient engagement is mediated through the mitigation of barriers is tested in joint linear structural equation models. Qualitative interviews explore how barriers impact engagement, especially for socioeconomically disadvantaged women. ETHICS AND DISSEMINATION: This protocol has been approved by the National Cancer Institute Central Institutional Review Board, and Certificate of Confidentiality has been obtained. We plan to disseminate the findings through journal publications and national meetings, including the NCORP network. Our findings will advance the science of medical decision-making with the potential to reduce socioeconomic health disparities. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03766009).


Subject(s)
Breast Carcinoma In Situ , Breast Neoplasms , Humans , Female , Adolescent , Adult , Male , Patient Participation , Breast Neoplasms/surgery , Decision Making , Mastectomy , Decision Making, Shared , Randomized Controlled Trials as Topic
12.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2408785.v1

ABSTRACT

This study aimed to estimate the individual patient’s lung and breast dose using the SSDE method as well as the effective dose in patients who underwent chest CT scans during the COVID-19 pandemic. The cancer risk incidence was estimated using excess relative risk (ERR), excess absolute risk (EAR), and lifetime attributable risk (LAR) models of biological effects of ionizing radiation report VII (BEIR-VII). The information of about 570 patients who underwent CT scans for COVID-19 screening was used for this study. Using the header of the CT images in a python script, SSDE and effective dose were calculated for each patient. The SSDE obtained by water equivalent effective diameter (wSSDE) was considered as lung and breast dose, and applied in organ-specific cancer risk estimation. The mean value of wSSDE for females (13.26 mGy) was a bit higher than the wSSDE value for males (13.08 mGy) but it was not statistically significant (P-value = 0.41). There was no significant difference in the calculated EAR, and ERR for lung cancer between males and females at the attained age of 5, and 30 years after exposure (P-value = 0.47, 0.46 respectively). There was no significant difference between lung cancer LAR values for females and males (0.48). The results also showed a decrease in the LAR values for both lung and breast cancers by increasing the exposure age. By considering the ALARA (as low as reasonably achievable) principle, the medical staff and the public should take the benefits of CT imaging in the detection of such infections. Besides, imaging medical physicists and CT scan experts have to optimize the imaging protocols and balance the image quality for detecting abnormalities versus the radiation dose based on the ALARA principle.


Subject(s)
Lung Neoplasms , COVID-19 , Neoplasms , Breast Neoplasms
13.
Int J Mol Sci ; 23(22)2022 Nov 11.
Article in English | MEDLINE | ID: covidwho-2143220

ABSTRACT

The assessment of molecular genetic landscape changes during NAC and the relationship between molecular signatures in residual tumors are promising approaches for identifying effective markers of outcome in breast cancer. The majority of the data in the literature present the relationship between the molecular genetic landscape and the response to NAC or are simply descriptive. The present study aimed to determine changes in expression profiles during NAC and assess the relationship between gene expression and the outcome of patients with luminal B HER2 breast cancer depending on distant hematogenous metastasis. The study included 39 patients with luminal B HER2-BC. The patients received 6-8 courses of NAC, and paired samples consisting of biopsy and surgical materials were analyzed. A full transcriptome microarray analysis was performed using the human Clariom™ S Assay platform (Affymetrix, 3450 Central Expy, Santa Clara, CA, 95051, USA). A comparison of the expression profiles of patients with breast cancer before and after NAC, depending on the status of hematogenous metastasis, was conducted. It was shown that the amount of DEGs in the tumor was reduced by more than six times after NAC. The top 10 signaling pathways were also found, the activity of which varied depending on the status of hematogenous metastasis before and after NAC. In addition, the association of DEGs with hematogenous metastasis in patients with breast cancer was evaluated: MFS was assessed depending on the expression level of 21 genes. It was shown that MFS was significantly associated with the expression level and pattern of nine genes. The expression levels of nine DEGs in the tumors of patients with breast cancer after NAC were significantly correlated with MFS when the status of hematogenous metastasis was taken into account.


Subject(s)
Breast Neoplasms , Neoadjuvant Therapy , Humans , Female , Breast Neoplasms/drug therapy , Breast Neoplasms/genetics , Breast Neoplasms/metabolism , Gene Expression Profiling , Neoplasm, Residual
14.
JCO Oncol Pract ; 18(9): e1447-e1453, 2022 09.
Article in English | MEDLINE | ID: covidwho-2140246

ABSTRACT

PURPOSE: The COVID-19 pandemic forced rapid adoption of telemedicine (TM) for breast oncology visits in the United States, but the appropriate role of postpandemic TM is uncertain. We sought to understand physician and advance practice practitioner perspectives on the use of TM for outpatient breast cancer care through an electronically administered survey. METHODS: Breast medical oncology clinicians at two academic cancer centers and five satellite locations affiliated with the Dana Farber Cancer Institute and the Massachusetts General Cancer Center were invited to respond to a 21-question survey administered in September 2021 about clinicians' perceptions and attitudes toward TM during the previous 12 months. RESULTS: Of the 71 survey invitations, 51 clinicians (36 physicians and 15 advance practice practitioners) provided survey responses (response rate = 72%). Ninety-two percent of respondents (n = 47) agreed that TM visits enhance patient care. Ninety-two percent of respondents (n = 46) also agreed that TM is valuable for early-stage breast cancer follow-up visits. Most respondents felt that there was no difference between TM and face-to-face (F2F) visits when it came to patient adherence, ease of ordering tests, ease of accessing patient records, and workflow outside of the visit (82%, 82%, 78%, and 53%, respectively). Fifty-one percent of respondents (n = 26) said that TM was better for timely access to follow-up appointments. Most respondents said that F2F visits were better for seeing physical problems, personal connection with patients, overall quality of visits, and patient-physician communication (100%, 75%, 65%, and 63%, respectively). CONCLUSION: Breast clinicians believe that TM is a valuable tool to enhance outpatient breast cancer care. TM was felt to be appropriate for routine follow-up visits and second opinion consultations and is as good as or better than F2F visits for several routine aspects of breast cancer care.


Subject(s)
Breast Neoplasms , COVID-19 , Oncologists , Telemedicine , Breast Neoplasms/therapy , COVID-19/epidemiology , COVID-19/therapy , Female , Humans , Pandemics , Surveys and Questionnaires , United States
15.
BMC Health Serv Res ; 22(1): 1403, 2022 Nov 23.
Article in English | MEDLINE | ID: covidwho-2139272

ABSTRACT

BACKGROUND: Women undergoing treatment for breast cancer require frequent clinic visits for maintenance of therapy. With COVID-19 causing health care disruptions, it is important to learn about how this population's access to health care has changed. This study compares self-reported health care utilization and changes in factors related to health care access among women treated at a cancer center in the mid-South US before and during the pandemic. METHODS: Participants (N = 306) part of a longitudinal study to improve adjuvant endocrine therapy (AET) adherence completed pre-intervention baseline surveys about their health care utilization prior to AET initiation. Questions about the impact of COVID-19 were added after the pandemic started assessing financial loss and factors related to care. Participants were categorized into three time periods based on the survey completion date: (1) pre-COVID (December 2018 to March 2020), (2) early COVID (April 2020 - December 2020), and later COVID (January 2021 to June 2021). Negative binomial regression analyses used to compare health care utilization at different phases of the pandemic controlling for patient characteristics. RESULTS: Adjusted analyses indicated office visits declined from pre-COVID, with an adjusted average of 17.7 visits, to 12.1 visits during the early COVID period (p = 0.01) and 9.9 visits during the later COVID period (p < 0.01). Hospitalizations declined from an adjusted average 0.45 admissions during early COVID to 0.21 during later COVID, after vaccines became available (p = 0.05). Among COVID period participants, the proportion reporting changes/gaps in health insurance coverage increased from 9.5% participants during early-COVID to 14.8% in the later-COVID period (p = 0.05). The proportion reporting financial loss due to the pandemic was similar during both COVID periods (34.3% early- and 37.7% later-COVID, p = 0.72). The proportion of participants reporting delaying care or refilling prescriptions decreased from 15.2% in early-COVID to 4.9% in the later-COVID period (p = 0.04). CONCLUSION: COVID-19 caused disruptions to routine health care for women with breast cancer. Patients reported having fewer office visits at the start of the pandemic that continued to decrease even after vaccines were available. Fewer patients reported delaying in-person care as the pandemic progressed.


Subject(s)
Breast Neoplasms , COVID-19 , Humans , Female , COVID-19/epidemiology , Pandemics , Breast Neoplasms/therapy , Longitudinal Studies , beta-Aminoethyl Isothiourea , Patient Acceptance of Health Care , Health Services Accessibility , Ambulatory Care Facilities
16.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.12.20.22283719

ABSTRACT

Background: We studied women enrolled in the Boston Mammography Cohort Study to investigate whether subgroups defined by age, race, or family history of breast cancer experienced differences in trends of screening or diagnostic imaging rates during the COVID-19 lockdown and had slower rebound in trends of these rates during reopening. Methods: : We compared trends of monthly breast cancer screening and diagnostic imaging rates over time between the pre-COVID-19, lockdown, and reopening periods and tested for differences in the monthly trend within the same period by age (<50 vs ≥50), race (White vs non-White), and first-degree family history of breast cancer (yes vs no). Results: : Overall, we observed a decline in breast cancer screening and diagnostic imaging rates. The monthly trend of breast cancer screening rates for women age ≥50 was 5% higher (p=0.005) in the pre-COVID-19 period but was 19% lower in the reopening phase than that of women aged <50 (p<0.001). White participants had 36% higher monthly trend of breast cancer diagnostic imaging rates than non-White participants (p=0.018). Discussion: The rebound in screening was lower in women age ≥50 and lower in non-White women for diagnostic imaging. Careful attention must be paid as the COVID-19 recovery continues to ensure equitable resumption of care. Funding: The project was supported by the Breast Cancer Research Foundation (RT). Researchers were supported by the University of Louisville CIEHS P30 ES030283 (NCD), K01CA188075 (ETW), T32CA09001 (NCD, MOS, MEB) P30 ES000002 (JH, FL), and NIH/NCI K00 CA212222 (MEB). This manuscript is the responsibility of the authors and does not represent the official views of the National Institutes of Health.


Subject(s)
COVID-19 , Breast Neoplasms
17.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2379786.v1

ABSTRACT

Background Adherence to oral endocrine therapy (OET) is crucial in ensuring its maximum benefit in prevention and treatment of hormone receptor-positive (HR+) breast cancer (BC) in patients. Medication use behavior is suboptimal especially in racial/ethnic minorities of lower socioeconomic status (SES). We aimed to assess the OET adherence and its predictors in racial/ethnic minority patients of lower SES.Aim We aimed to assess the OET adherence and determine the predictors of OET nonadherence in racial/ethnic minority patients of lower SES.Method A retrospective study was conducted at the Harris Health System in Houston, Texas. Since the study period included the COVID-19 pandemic, data was collected during the 6 months prior and 6 months after the start of the pandemic. The adherence was assessed using the prescription refill data using the proportion of days covered. Multivariable logistic regression model was used to identify predictors of nonadherence. Eighteen years or older patients on appropriate doses of OET for prevention or treatment of BC were included.Result In 258 patients, the adherence was significantly lower during the pandemic (44%) compared to before the pandemic (57%). The predictors of OET nonadherence before the pandemic were Black/African American, obesity/extreme obesity, prevention setting, tamoxifen therapy, and 4 or more years on OET. During the pandemic, prevention setting and those not using home delivery were more likely to be nonadherent.Conclusion Racial/ethnic minority patients of lower SES, especially African Americans and those using OET for prevention of BC, require individualized interventions to improve adherence.


Subject(s)
COVID-19 , Obesity , Breast Neoplasms
18.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2378692.v1

ABSTRACT

Background Global annual cancer incidence is forecast to rise to 27.5M by 2040, a 62% rise from 2018. For most cancers, prevention and early detection are the most effective ways of reducing mortality. This study maps trials in cancer screening, prevention and early diagnosis (SPED) to identify areas of unmet need and highlight research priorities.Methods A systematic mapping review was conducted to evaluate all clinical trials focused on cancer SPED, irrespective of tumour type. The National Cancer Research Institute (NCRI) portfolio, EMBASE, PubMed and Medline were searched for relevant papers published between 01/01/2007 and 01/04/2020. References were exported into Covidence software and double-screened. Data were extracted and mapped according to tumour site, geographical location, and intervention type.Results 117,701 abstracts were screened, 5157 full texts reviewed, and 2888 studies included. 1184 (52%) trials focussed on screening, 554 (24%) prevention, 442 (20%) early diagnosis and 85 (4%) a combination. Colorectal, breast and cervical cancer comprised 61% of all studies compared with 6.4% in lung and 1.8% in liver cancer. The latter two are responsible for 26.3% of global cancer deaths compared with 19.3% for the former three. Number of studies varied markedly according to geographical location; 88% were based in North America, Europe or Asia.Conclusions This study shows clear disparities in the volume of research conducted across different tumour types and according to geographical location. These findings will help drive future research effort so that resources can be directed towards major challenges in cancer SPED.


Subject(s)
Mental Disorders , Colorectal Neoplasms , Neoplasms , Breast Neoplasms , Carcinoma, Hepatocellular
19.
Eur J Cancer ; 177: 72-79, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2117958

ABSTRACT

AIMS: We analysed the impact of the SARS-CoV-2 pandemic (COVID-19) on the quality of breast cancer care in certified EUSOMA (European Society of Breast Cancer Specialists) breast centres. MATERIALS AND METHODS: The results of the EUSOMA quality indicators were compared, based on pseudonymised individual records, for the periods 1 March 2020 till 30 June 2020 (first COVID-19 peak in most countries in Europe) and 1 March 2019 till 30 June 2019. In addition, a questionnaire was sent to the participating Centres for investigating the impact of the COVID-19 pandemic on the organisation and the quality of breast cancer care. RESULTS: Forty-five centres provided data and 31 (67%) responded to the questionnaire. The total number of new cases dropped by 19% and there was a small significant higher tumour (p = 0.003) and lymph node (p = 0.011) stage at presentation. Comparing quality indicators (12,736 patients) by multivariable analysis showed mostly non-significant differences. Surgery could be performed in a COVID-free zone in 94% of the centres, COVID testing was performed before surgery in 96% of the centres, and surgical case load was reduced in 55% of the centres. Modifications of the indications for neoadjuvant endocrine therapy, chemotherapy, and targeted therapy were necessary in 23%, 23%, and 10% of the centres; changes in indications for adjuvant endocrine, chemo-, targeted, immune, and radiotherapy in 3%, 19%, 3%, 6%, and 10%, respectively. CONCLUSION: Quality of breast cancer care was well maintained in EUSOMA breast centres during the first wave of the COVID-19 pandemic. A small but significantly higher tumour and lymph node stage at presentation was observed.


Subject(s)
Breast Neoplasms , COVID-19 , Humans , Female , Pandemics , SARS-CoV-2 , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/therapy , Breast Neoplasms/pathology , COVID-19 Testing
20.
Clin Lab ; 68(11)2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2116345

ABSTRACT

BACKGROUND: This study evaluates the seroprevalence of immunoglobulin M (IgM) and G (IgG) antibodies against SARS-CoV-2 after two doses of Pfizer-BioNTech COVID-19 vaccination from women with breast cancer in Jazan city Kingdom of Saudi Arabia, antibody detections were performed one month and three months after the administration of the second dose. METHODS: Overall, 103 breast cancer patients were included. Individuals who had had two doses of Pfizer-BioNTech vaccine, patients who were earlier diagnosed with COVID-19 infection, had not finalized immunization plan, or who received the second dose recently were excluded from the study. The antibodies detection test was run according to the manufacturer's directions of Viva Diag™ SARS-CoV-2 IgM/IgG Rapid Test (COVID-19 IgM/IgG Rapid Test). RESULTS: This study included 62 (60.2%) and 41 (39.8%) patients with invasive ductal carcinoma and invasive lobular carcinoma, respectively. The age, median and interquartile range (IQR) was 54.0 (26) years. Regarding reactivity of antibodies, after one month IgM antibody showed 64 (62.1%) positive and 39 (37.9%) negative while IgG antibody showed positive results in all patients. After three months IgM antibody showed 44 (42.7%) positive and 59 (57.3%) negative, while IgG showed 87 (84.5%) positive and 16 (15.5%) negative. There were significant differences in the IgM and IgG seropositivity. There were 19.3% patients with ductal carcinoma who were positive and then turned negative versus 17.7% who were positive and then turned negative, respectively (p < 0.001). There were significant differences in IgM antibody positivity among different age groups. CONCLUSIONS: Our results recommend the importance of screening for an antibody response for breast cancer patient after immunization in order to reveal persons who need early and late extra enhancing vaccine dose. Upcoming studies recommended to estimate different methods that raise cancer patients' immune response.


Subject(s)
Breast Neoplasms , COVID-19 , Carcinoma, Ductal , Humans , Female , Middle Aged , SARS-CoV-2 , Immunoglobulin M , Seroepidemiologic Studies , COVID-19/epidemiology , COVID-19/prevention & control , BNT162 Vaccine , COVID-19 Vaccines , Antibodies, Viral , Immunoglobulin G
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